the opioid crisis

[onethatcares]

I've been wondering when it started and why in the beginning it affected the low income people of W VA, Kentucky, Tenn., Ark, and environs.

If I'm to believe opioids are the hydro and Oxycontin's, they require scripts to get them and a doctor visit requires money or insurance.
Correct? It's not like heroin and fontanel, or is it?

Where the the addicts and overdosers obtain and how?

I hope this makes sense.

[dawg]

1. In many cases it starts with prescriptions and then switches to heroin ...

for reasons of affordability.

[MineralMan]

2. Fentanyl, not fontanel.

And Fentanyl is also a prescription medication, used in cases of severe chronic pain. Generally, it comes in the form of time-release skin patches.

Fontanelle - Wikipedia
https://en.wikipedia.org/wiki/Fontanelle
A fontanelle (or fontanel) (colloquially, soft spot) is an anatomical feature of the infant human skull comprising any of the soft membranous gaps (sutures) ...

[Thirties Child]

3. Suicide by Fentanyl patches

After he retired, my husband worked as an as-needed death investigator in NM. One woman died with a mouthful of Fentanyl patches.

[MineralMan]

4. Yes. That happens.

Chronic, severe pain is a very common reason for suicide. Dealing with intractable pain is an issue that is often forgotten in the discussion of the misuse of opioid medications. Many doctors are now afraid to prescribe them in quantities that can actually make people suffering from such pain comfortable enough not to consider suicide.

There are legitimate medical uses for the most powerful pain medications. We should not prevent their use by those who need them to have some acceptable quality of life without excruciating pain. I fear that we will legislate such people into suicide.

[Thirties Child]

5. I agree people in unbearable pain need help.

My sister has severe scoliosis, spinal stenosis and Parkinson's. Some days the pain is so bad she can barely walk. She needs help.

[onethatcares]

12. thank you.

I hit spell check and away it went. I should have looked at my post better.

[Achilleaze]

6. note that the proposed republican TrumpCare bill slashes funds for

opioid programs.

The repubes are just going to let Big Pharma, Inc. (R) keep shoving their opioid crap down the throats of the American people, and creating a weak, dependent nation of untreated addicts.

deplorable.

[kentuck]

7. I think they were shipped from Florida to SE Kentucky....

and that is where it started.

It has now spread thru West VA, OH, and up thru New England. Many in Appalachia have moved on to heroin.

The opioids have spread across our entire country.

[blueinredohio]

8. This has been going on for longer than most people think

doctors would give anything you want. They're in it for the money. But it wasn't until it started affecting rich kids did it get attention. Lieutenant Governor of Ohio on t.v. last week said she has one son in rehab and one just got out. Explains all the attention to puppies now.

[dalton99a]

9. There is an excellent series on this:

https://www.washingtonpost.com/unnatural-causes/
Unnatural Causes: Sick and dying in small-town America

[Aristus]

10. Every time the subject of the opioid over-prescribing crisis comes up,

prescribing medical providers (like me) get dumped on from a great height for not unlimbering our prescription pads for everyone who comes in asking for a powerful oral opioid medication.

In truth, we are required to exercise a great deal of simple clinical good judgement when writing for narcotic medications. Some providers are less judicious than others, obviously; and that gets us all in trouble.

If a patient comes in with a history of chronic musculoskeletal pain, a motor vehicle accident, diagnostic imaging showing degenerative changes or vertebral malalignment, elevated heart rate and blood pressure, a reported pain level of 8 out of 10, and is currently undergoing physical therapy, therapeutic massage, and orthopedic care, this patient will very likely get an opioid prescription that is monitored and regulated in a proper clinical manner.

But if I go into the exam room and there's this twenty-year old kid in no evident distress, no notable adverse medical history, blood pressure and heart rate normal, complaining of "fifteen out of ten, man; it's just the worst!", listing his medication allergies as "everything but Percocet" (and having a pet name for his pet medication is another warning sign - "I gotta have my Percs!&quot , and irritably demanding an opioid prescription, then I'm sending him on a do-not-pass-GO trip out the front door empty-handed.

[Lee-Lee]

11. As for where the drugs come from

You have several sources:

Stolen meds- people will steal opiate medication from anyone they can. I've seen cases where people followed a person out of the pharmacy and broke into the home that night. I've seen lots of cases of people stealing from parents/grandparents. Lots of theft by staff in nursing homes and home health aides who record that a patient got meds and pocket them.

Pill mill doctors- they don't last long because the DEA will track and shut them down, but some doctors find easy money in being the doc who will write a monthly script for a "back pain" as long as that "patient" pays for that monthly visit in cash or they can bill Medicaid. It may be that the person is using the narcotics, it may be they are selling them.

Drug seekers in ER's and urgent care facilities- These folks will fake an illness or injury or even self injure to get a prescription and some pills in the ER. I worked an off-duty job as security in the ER and easily 25-35% of the people some nights had no issues and were faking. They will spend days sometimes traveling all around to different facilities in different states even. They may consume what they get, they may sell, usually some of both.

Legitimate patients or those who start legitimate who choose to sell them- Sometimes it's because they need the money worse, sometimes they just don't need all they are prescribed and just sell them. I remember one case where the woman's back pain had gone away but she kept complaining to her doctors to keep getting prescriptions and selling them because she said that since Medicaid paid them she felt like it was ok for her to resell them for extra money.

From other countries- increasingly prescription opioids are trafficked across the border, especially from Mexico and some places in the Caribbean where oversight of pharmacies is lax and bribes can make sure the ones trafficking stay in operation.